Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2022; 28(46): 6599-6618
Published online Dec 14, 2022. doi: 10.3748/wjg.v28.i46.6599
Correlation between COVID-19 and hepatitis B: A systematic review
Yan-Fei He, Zhi-Gang Jiang, Ni Wu, Ning Bian, Jun-Lin Ren
Yan-Fei He, Ni Wu, Ning Bian, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Zhi-Gang Jiang, Department of Statistics, Zunyi Medical University, Guizhou 563006, Guizhou Province, China
Jun-Lin Ren, Department of Infection Control, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Author contributions: He YF designed the study, reviewed the literature, and drafted the manuscript; Jiang ZG and Wu N retrieved and summarized the literature; Ren JL and Bian N advised on the review and reviewed the final manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Fei He, MD, Associate Chief Physician, Doctor, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China. heyanfeilc@163.com
Received: September 11, 2022
Peer-review started: September 11, 2022
First decision: October 19, 2022
Revised: October 29, 2022
Accepted: November 19, 2022
Article in press: November 19, 2022
Published online: December 14, 2022
ARTICLE HIGHLIGHTS
Research background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hepatitis B virus (HBV) infections are two major current global public health crises. Both SARS-CoV-2 and HBV infections can cause liver damage. It is unclear whether HBV itself makes patients more susceptible to coronavirus disease 2019 (COVID-19), or whether COVID-19 leads to worse outcomes in patients with HBV infection. There are few and conflicting data on the association between COVID-19 and hepatitis B.

Research motivation

All current studies on patients with both COVID-19 and hepatitis B will be searched to explore the complex relationship between COVID-19 and hepatitis B in order to inform the research and management of patients co-infected with SARS-CoV-2 and HBV.

Research objectives

We searched almost all current clinical studies on COVID-19 combined with hepatitis B to describe their interaction, possible mechanisms, and clinical interventions to inform the clinical management of this special population with SARS-CoV-2 and HBV co-infection.

Research methods

We used an inclusive search strategy and searched the literature in the following online databases: PubMed, China National Knowledge Infrastructure, Google Scholar, Scopus, Wiley, Web of Science, Cochrane, and ScienceDirect, as well as medRxiv and bioRxiv, and also manually searched references of the included studies. Articles reporting studies conducted in humans and discussing hepatitis B and COVID-19 were included. We extracted the relevant data from the full text of eligible studies for the table after excluding duplicative publications. Some topics that included HBV or COVID-19 samples but did not have quantitative evidence were excluded from the review.

Research results

After excluding duplications and publications without quantitative evidence, a total of 57 studies were eligible and included in this review; all were retrospective, and they were from 11 countries. Most of the studies suggested an interaction between hepatitis B and COVID-19, mainly in the form of abnormal liver enzymes, abnormal blood parameters, and HBV reactivation; however, 12 of these studies clearly indicated no effect between hepatitis B and COVID-19.

Research conclusions

Both SARS-CoV-2 and HBV are both globally pathogenic viruses, and there are few and conflicting data on the potential association between COVID-19 and hepatitis B. Our review provides direct evidence for some associations between COVID-19 and hepatitis B, explains the clinical phenomena that they exhibit, explores the possible mechanisms of the interaction between COVID-19 and hepatitis B, and provides management measures for co-infected patients.

Research perspectives

To our knowledge, our review is the most comprehensive report to date describing the association between COVID-19 and hepatitis B. In the future, high-quality randomized trials are needed to further elucidate the interaction between COVID-19 and hepatitis B.